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Anxiety Disorders

What You Need to Know About Depersonalization and Anxiety

Have you ever felt that you are not in your own body, but cut-off, detached completely? Like you were a distant observer of your actions and speech and you were floating above your body?

The experience was so unusual and scary that you didn’t say a word to anyone? Well, that may have been depersonalization. 

We connect depersonalization with anxiety. However, researchers confirmed that depersonalization is a disorder just like anxiety disorders. It is called dissociative disorder.

After depression and anxiety, depersonalization is the most frequent symptom seen in psychiatry (Lars, 2010). Even so, we hear little about it. Why? Well, first because it is difficult to put into words and describe exactly the experience. And then people are afraid they will be perceived as crazy.

Spectrum of Severity – From Symptom to Disorder

Mauricio Sierra, a well-known scholar and researcher of Depersonalization, points out in his book to a spectrum of severity. According to him we can understand better the severity of DP by placing it in one of the three following stages:

1. The non-clinical form or ‘normal depersonalization’

unhappy thoughtful teen girl arms crossed in rainy day
Photo by Khoa Võ on Pexels.com

These are the brief episodes that usually youngsters experience during stressful situations or anxiety-provoking experiences. It’s interesting to note that researchers found a common occurrence in young people, with a prevalence ranging from 30% to 70%. First time I experienced Depersonalization was in the secondary school so it must be true.

The fleeting form of DP in childhood / teenage years can progress to a much more severe form in the context of anxiety (Sierra, 2009).

2. Depersonalization as a symptom of anxiety or depression

When Depersonalization appears in combination with other disorders like anxiety or depression. Episodes are more frequent, longer lasting, and encompass more symptom domains (e.g. derealization, depersonalization, desomatization or de-affectualization).

3. The pathological form

The pathological form when Depersonalization becomes a psychiatric illness in its own right. This is when Depersonalization is present almost all the time and it can become debilitating. The episodes of Depersonalization are persistent, don’t occur only in the context of another psychiatric condition. Also, people experience significant life distress or dysfunction as a result. 

Depersonalization With Anxiety

Overwhelming anxiety (triggered by an accident, shock) can act as a powerful trigger of such episodes. With an accident or a life-threatening situation, the individual does not have control and depersonalization will create a state where he can detach emotionally from what is happening depersonalization becomes a defence mechanism. So this is a normal situation where DP comes like a buffer.

What happens when there is no threat or trauma for DP to protect you from? 

When DP appears as a symptom of your anxiety, you are afraid that you are getting crazy or that you have lost control over yourself. This causes more anxiety, which causes further DP episodes.

Address your anxiety first and you will manage, control and recover from Depersonalization. Check this Depersonalization Manual channel on YouTube that may give you some useful tips.

Depersonalization Disorder

What happens when anxiety stops, but Depersonalization continues?

Researchers associate anxiety with mild Depersonalization (Sierra et al., 2012).  But the role of anxiety has become overemphasized, at the expense of chronic depersonalization. Researchers made no similar association in patients with severe depersonalization. Therefore, they consider DP a disorder and not just a symptom of anxiety. That is when Depersonalization becomes a chronic, distressing and incapacitating condition in its own right.

People end up being treated for depression or anxiety, even though they were depressed or anxious only initially. People are conscious they are struggling most with are feelings of “unreality,” “deadness,” or “no self”  which differs from having just anxiety or depression.

A distinction between DPD and depression or anxiety lies in how depersonalization symptoms occur alongside depression or anxiety symptoms. If depression and anxiety wax and wane, does depersonalization follow along, or does it have a life of its own?

“The anxiety makes it worse, but the depersonalization is always there: they don’t just go hand in hand with each other.”

Another clue is that anxiety makes DP feel more severe. 

Depersonalization Symptoms – What It Feels Like

In his book, Mauricio Sierra organizes the symptoms of Depersonalization into 4 major components.

1. An experience of feeling cut-off or alienated from surroundings

When it feels like being separated from the world by an invisible barrier such as a pane of glass, a fog or a veil.

I see, I hear, I feel, they say, but the object does not reach me; I cannot receive the sensation; It seems to me as if there was a wall between me and the external world.

(Griesinger, 1845 cited by Sierra, p. 157)

2. Detachment from personal memories

Depersonalized people experience time differently (alterations in the sense of duration and of the perspective of time).

It seems as if things that I have recently done had taken place a long time ago.

(Baker et al., 2003 cited by Sierra, p.35)

3. Emotional numbing

This is not the inability to feel emotions. You can still experience fear, excitement, sadness or happiness. But because you perceive the world around you as ‘unreal’ you are not ‘moved’ by those objects or events. For example, you cross the road and notice a street dancing show and you like dance, but this time you don’t feel you are really there so it does not impress you much.

I am looking at people, know who they are, but can’t place myself there.

(Sierra, 2012)

4. Detachment from the body

Lack of body ownership feelings

I do not feel I have a body. When I look down, I see my legs and body, but it feels as if it was not there. When I move, I see the movements as I move, but I am not there with the movements. While walking up the stairs; I see my legs and hear footsteps and feel the muscles but it feels as if I have no body; I am not there.

(Sierra, 2012)

Feelings of loss of agency (feeling like on auto-pilot)

Mauricio Sierra talks about two components of the mental agency: the experiential component and the cognitive attributional one. In depersonalization, the experiential component of agency is lacking, but the cognitive ability to attribute those acts to the ‘self’ is intact.

For example, you are running in the park and you can feel your body and muscles moving, but you cannot place yourself there in your body. It is frightening because you may hit something and you are afraid of not being able to command your body to stop. YOUR THOUGHTS AND ACTIONS ARE STILL YOURS BUT YOU DON’T FEEL IT.

I talk and the words are just coming out. I don’t feel I have control over what I’m saying. It’s like auto-pilot has been switched on. My voice doesn’t sound like ‘me’ when it is coming out. Sometimes I wonder how I get through conversations as I don’t feel I am there at all. 

(Sierra, 2012)

Feelings of disembodiment or being a detached observer of one’s own actions

It seems to me as if I am split into two; I lose the awareness of my body, which feels as if it is in front of me, I walk, and I am aware of it but I do not have an awareness of my own identity, that it is actually me who is walking.

(Séglas, 1895, p. 131)

How To Manage Depersonalization

Depersonalized people struggle to function well in school or at work because they feel so foggy, spacey, or obsessively preoccupied with trying to figure out their condition. Their relationships are affected because of the distorted sense of connectedness with others.

DP is complex and multilayered, and many times misunderstood. There is no simple way to define DP and locate yourself on the spectrum of severity. Some symptoms are common, while others only appear sometimes.

If DP only lasts for a few seconds and it is anxiety based, start with addressing your anxiety. If DP episodes are affecting your life and you feel desperate and alone, you need help. 

The only thing is, not all the doctors are prepared to handle DP.  It is important to get an accurate diagnosis. This is the right direction to the road to improvement and recovery. It is important to visit a clinician who is familiar with DP literature and who won’t hurry to put a diagnosis.

The diagnosis of DPD can be assisted by the use of various interviews and scales. A thorough one is Cambridge Depersonalization Scale

You can do a Depersonalization test here

BUT this is not a quick test to determine whether you have DPD. It is just a tool that one can use in the process of diagnosis. A person-to-person interview by a knowledgeable, professional clinician remains a crucial element.

How Can You Help Someone With Depersonalization Disorder

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Start from knowing that people with DP are not crazy or delusional. Be open enough to have honest conversations with them.

Create a safe space where they can discuss their thoughts, however bizarre, and their feelings with no fear of being judged. Being listened to can have a therapeutic effect. The knowledge that the condition is real and they can share (no matter how difficult is to describe DP) their experience with someone it is a tremendous relief.

Both patients and loved ones should reinforce the fact that DPD presents itself in “as if” experiences. Individuals with DPD have not lost their self; it only feels as if they have. So avoid getting into lengthy philosophical arguments if possible; the powers of pure reason are strained when battling sensations that defy conventional logic.

(J. Abugel and D. Simeon., 2006)

Can You Recover Without Medication?

Yes, if the circumstances that triggered Depersonalization no longer have the same impact over the individual. For example, when the shock of an extreme experience (e.g. car crash) recedes depersonalization may gradually ease. It can also happen after you stopped using some drugs like marijuana (marijuana, hallucinogens, ecstasy, and ketamine are primary drugs that trigger DP). Symptoms may also disappear when you are out of a stressful situation.

With DP as a symptom of anxiety or depression, addressing the anxiety will automatically calm down DP (see DP manual).

Some people feel in control of depersonalization symptoms but some others are crippled by fear and the discomfort of those symptoms

Conclusion

Depersonalization is a complex experience. It is meant to protect you from traumatic events, so don’t think of it as an enemy.

It can be a transient symptom of anxiety or a chronic disorder.

Depersonalization affects more people than you would expect. You are not crazy; you are not alone. There are many forums / groups out there where people share their stories. Still, the online information is never as reliable and helpful as a certified doctor.

It’s hard to live with Depersonalization. No matter how much you try to use the right words to capture the experience, you still find yourself struggling to describe how it feels. Still, this subject is slowly getting the attention of researchers and the more we educate ourselves about it, the easier it gets to find a path towards recovery.

Beneath the fog of the feeling of no self, may in fact lay a fiercely individualistic personality that has been held in check by fear. That self has not disappeared; it just feels as if it has.

(J. Abugel and D. Simeon., 2006)

Useful Resources

Feeling Unreal: Depersonalization Disorder and the Loss of the Self by Daphne Simeon (2008).

Depersonalization: A New Look at a Neglected Syndrome by Mauricio Sierra (2012).

Hi! I'm Maria and I am a mental health advocate! I am determined to learn as much as I can about mental and emotional wellbeing.

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